Outcomes of a hospital-wide plan to improve care of comatose survivors of cardiac arrest.
BACKGROUND
Therapeutic hypothermia (TH) improves outcomes in comatose survivors of cardiac arrest. Few hospitals have protocol-driven plans that include TH. We implemented a series of process interventions designed to increase TH use and improve outcomes in patients successfully resuscitated from out-of-hospital cardiac arrest (OHCA) or in-hospital cardiac arrest (IHCA).


RESULTS
Linked interventions including a TH order sheet, verbal and written feedback to individual providers, an educational program, TH "kit" and on-call consultants to assist with patient care and hypothermia induction were implemented between January 1, 2005 and December 31, 2007 in a large, university-affiliated, tertiary care center. We then completed a retrospective review of all patients treated for cardiac arrest during the study period. Descriptive statistics, chi-squared analyses, or Fisher's exact test were used as appropriate. A p value <0.05 was considered significant. 135 OHCA patients and 106 IHCA patients were eligible for post-arrest care. TH use increased each year in the OHCA group (from 6% to 65% to 76%; p<0.001) and IHCA group (from 0% to 36% to 53%; p=.02). A good outcome was achieved in 21% and 8% of comatose patients with OHCA and IHCA, respectively. Patients with OHCA and ventricular dysrhythmia were more likely to have a good outcome with TH treatment than without it (good outcome in 57% vs. 8%; p=.005).


CONCLUSIONS
Implementing a series of aggressive interventions increased appropriate TH use and was associated with improved outcomes in our facility.
Rittenberger
Jon C
JC
Department of Emergency Medicine, University of Pittsburgh, United States. rittenbergerjc@upmc.edu
Guyette
Francis X
FX
Tisherman
Samuel A
SA
DeVita
Michael A
MA
Alvarez
Rene J
RJ
Callaway
Clifton W
CW
D000328:Adult; D000368:Aged; D002985:Clinical Protocols; D015331:Cohort Studies; D003128:Coma / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006323:Heart Arrest / Q000523:psychology / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D012151:Resuscitation; D012189:Retrospective Studies